Does one workshop on respecting cultural differences increase health professionals’ confidence to improve the care of Australian Aboriginal patients with cancer? An evaluation

Abstract

BackgroundAboriginal Australians have worse cancer survival rates than other Australians. Reasons include fear of a cancer diagnosis, reluctance to attend mainstream health services and discrimination from health professionals. Offering health professionals education in care focusing on Aboriginal patients’ needs is important. The aim of this paper was to evaluate whether participating in a workshop improved the confidence of radiation oncology health professionals in their knowledge, communication and ability to offer culturally safe healthcare to Aboriginal Australians with cancer.MethodsMixed methods using pre and post workshop online surveys, and one delivered 2 months later, were evaluated. Statistical analysis determined the relative proportion of participants who changed from not at all/a little confident at baseline to fairly/extremely confident immediately and 2 months after the workshop. Factor analysis identified underlying dimensions in the items and nonparametric tests recorded changes in mean dimension scores over and between times. Qualitative data was analysed for emerging themes.ResultsFifty-nine participants attended the workshops, 39 (66% response rate) completed pre-workshop surveys, 32 (82% of study participants) completed post-workshop surveys and 25 (64% of study participants) completed surveys 2 months later. A significant increase in the proportion of attendees who reported fair/extreme confidence within 2 days of the workshop was found in nine of 14 items, which was sustained for all but one item 2 months later. Two additional items had a significant increase in the proportion of fair/extremely confident attendees 2 months post workshop compared to baseline. An exploratory factor analysis identified three dimensions: communication; relationships; and awareness. All dimensions’ mean scores significantly improved within 2 days (p < 0.005) and persisted to 2 months. The workshop raised awareness about barriers and enablers to delivering services respectful of cultural differences, led to a willingness to reflect on pre-existing beliefs and assumptions about Aboriginal Australians that in some cases resulted in improved care.ConclusionSingle workshops co-delivered by an Aboriginal and non-Aboriginal presenter can be effective in building health professionals’ confidence and translating into practice knowledge of respectful care of Aboriginal patients with cancer. Sustaining improvements may require integrating this approach into ongoing professional development.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2599-z) contains supplementary material, which is available to authorized users.

Reflexive Practice as an Approach to Improve Healthcare Delivery for Indigenous Peoples: A Systematic Critical Synthesis and Exploration of the Cultural Safety Education Literature

“…Where documents described the process of reflexivity, a variety of terms was used. The most common descriptors included ‘reflect on’ [ 21 , 22 , 23 , 27 , 30 , 31 , 32 , 33 , 36 , 56 , 64 , 66 , 67 , 68 , 73 , 80 , 90 ]; ‘examine’ [ 16 , 17 , 25 , 61 , 71 , 72 ]; ‘become aware of’ [ 17 , 18 , 36 , 63 , 68 , 75 , 88 ]; ‘explore’ [ 17 , 18 , 36 , 63 , 68 , 75 , 88 ]; ‘consider’ [ 29 , 56 , 67 , 68 ]; ‘understanding’ [ 36 , 58 , 87 ]; and ‘identify’ [ 21 , 64 , 67 , 72 , 89 ]. What is notable about these descriptors is that most—including all the most commonly used—describe a passive process of identification, observation, and awareness.…”

“…Thirty-five of the documents analysed described the sub-theme of held beliefs, where learners were required to identify and articulate their current knowledge, attitudes, biases, power, and privilege specifically in relation to Indigenous peoples [ 16 , 17 , 19 , 20 , 21 , 22 , 23 , 25 , 26 , 29 , 30 , 31 , 33 , 36 , 38 , 54 , 55 , 57 , 58 , 59 , 60 , 62 , 63 , 64 , 66 , 67 , 69 , 70 , 73 , 80 , 81 , 83 , 87 , 90 , 91 ]. In most of these educational interventions, learners were required to reflect on both self-identity and held beliefs, and these were conceptualised as related.…”

“…Object catalysts were described in 27 of the educational interventions analysed, and included things like readings, case studies, stories, visual art, and films [ 17 , 20 , 23 , 24 , 29 , 30 , 31 , 32 , 33 , 36 , 38 , 56 , 59 , 62 , 63 , 64 , 66 , 67 , 68 , 69 , 71 , 73 , 84 , 85 , 87 , 90 , 91 ]. Reflexive engagement with object catalysts was most often depicted as small or large group discussions, where new knowledge and understanding was co-produced through the sharing of beliefs, experiences, and interpretations.…”

“…In 13 of the educational interventions analysed, Indigenous educators were positioned as the reflexive catalysts, either as core teaching staff [ 17 , 36 , 56 , 57 , 68 , 71 , 90 ] or in ad hoc roles such as guest speakers [ 19 , 21 , 60 , 64 ] or patient simulation actors [ 28 , 63 , 86 ]. Indigenous educators were frequently described as providing learners with an opportunity to challenge their own stereotypes and beliefs about Indigenous peoples, as exemplified in the following extract:…”

Development and feasibility testing of a training programme for community pharmacists to deliver a culturally responsive medication review intervention

“…A 2018 systematic review of health workforce cultural competence interventions suggested health outcomes could be improved by prioritising practical skills development in training and monitoring the consistent application of these skills in healthcare encounters [ 7 ]. A later study similarly found that a single workshop could be effective in building health professionals confidence in providing culturally safe care for Indigenous Australians and that this improvement was sustained at two months [ 9 ].…”